Environmental Engineering Reference
In-Depth Information
PrIncIPAl Person dAtA
4 of 4
For.Fatals:. CAUSE.OF.DEATH:.._______________________________________________________________________
. DATE.OF.DEATH:.________________________.Time.of.Death:.________________________.
State.of.Health.at.Time.of.Accident:..______________________________________________________
____________________________________________________________________________________
INJURIES.FROM.ACCIDENT:.. _________________________________________________________
____________________________________________________________________________________
Blood.Chemistry.(Must.Include.Alcohol.and.Carbon.Monoxide):.._______________________________
Attach.Photographs.of.Victim.and.Close-Up.Photograph.of.Injury:
. Check.(..).When.Complete.
Attach.Medical.Examiner's.Report.if.Available.
